Nephrectomy for benign disease in the UK: results from the British Association of Urological Surgeons nephrectomy database.

OBJECTIVE: To summarize the practice of UK urologists with regard to nephrectomy for benign disease, documenting the indications, procedural techniques and outcomes. METHODS: All patients undergoing nephrectomy for a benign condition in 2012 were identified from the British Association of Urological Surgeons (BAUS) nephrectomy database. Recorded variables included the technique of surgery, the type of minimally invasive procedure, operating time, blood loss, transfusion rate, conversion rate, intra- and postoperative complications and mortality rate. Cases were also sub-analysed according to their pathologies to determine the differences in complication rate between stone disease, pyelonephritis, non-functioning kidney and other benign lesions. To contextualize procedural complexity, the simple nephrectomy data were compared with those obtained from the BAUS stage T1 radical nephrectomy audit. RESULTS: A total of 1 093 nephrectomies were performed (537 non-functioning kidneys, 142 stone disease, 129 nephrectomies secondary to pyelonephritis and 285 cases with other benign conditions). Of these, 76% were performed laparoscopically. Blood loss >500 mL was noted in 74 cases with a 4.8% blood transfusion rate. The intra- and postoperative complication rates were 5.2 and 11.9%, respectively. Of the 847 minimally invasive procedures, the conversion rate was 5.9%. Patients with stone disease have the highest intra- and postoperative complications (9.9 and 23.9%, respectively) compared with other benign pathologies. The total number of T1 radical nephrectomies performed was 1 095. In comparison with T1 radical nephrectomy, simple nephrectomy carries an increased risk of conversion to an open procedure (1.8 times), a higher rate of blood transfusion (4.8 vs 2.8%), and a higher risk of intra- and postoperative complications (5.2 vs 3.7% and 11.9 vs 10%, respectively). CONCLUSION: The present study reports the largest series of nephrectomies performed for benign disease and the resultant data now support the bespoke preoperative counselling of patients. Furthermore, it confirms the commonly held view that simple nephrectomy can be more difficult than its radical counterpart. The authors suggest that the term 'simple nephrectomy' is changed to 'benign nephrectomy'.

Effects of recliner-chair versus traditional hospital bed on postsurgical diagnostic laparoscopic recovery time.

Little has been documented regarding postoperative nursing interventions that are effective in decreasing postoperative recovery time, improving patient outcomes, or optimizing discharge readiness. A randomized study was conducted to evaluate 2 methods of recovery positioning and to examine factors that affect home readiness (eg, voiding, intake) for postsurgical laparoscopy patients. Participants were randomized into 2 groups. The control group was recovered in traditional hospital beds, while subjects in the experimental group recovered in a "recliner-chair," which was adjustable by the patient for comfort. The results showed that patients who recovered in adjustable recliner-chairs reached home readiness sooner and experienced greater comfort levels than patients who recovered in traditional hospital beds. Furthermore, patients in the recliner-chair group had fewer adverse symptoms such as nausea, severe pain, and delayed voiding. This is a U.S. government work. There are no restrictions on its use.